Introduction to paper
Between 2001 and 2003 there was a dramatic decline in the prescribing of menopausal hormone therapy (MHT) globally following the first publication of findings from the Women’s Health Initiative (WHI) estrogen–progestin study linking MHT use to an increase in breast cancer risk [1]. The use of MHT fell by approximately 40% in Australia [2], with even greater declines in Canada [3] and the USA [4]. Concomitantly, a hiatus developed in training of medical trainees and clinicians, and allied health professionals, in the management of menopause. A 2017 survey of trainees in family medicine, internal medicine, and obstetrics and gynecology in the USA reported that 20% had not had lectures on menopause in their residency and only 6.8% felt ‘adequately prepared to manage women experiencing menopause’ [5,p.242].
While approximately one-third of postmenopausal Australian women under the age of 55 years experience moderate to severe vasomotor symptoms [6], only 11% of women in this age group use MHT [7]. Our recent qualitative study revealed that although most Australian women understand what happens at menopause, few were aware of the long-term health consequences such as bone loss and increased risk of cardiovascular disease [8]. Furthermore, women generally viewed MHT in a negative light, particularly in relation to breast cancer risk.
The aim of the current study was to explore the understanding and views of Australian health-care providers, specifically general practitioners (GPs), gynecologists (GYs) and pharmacists (PHs), about menopause and its management. We were also interested in how confident health practitioners were in managing menopause with respect to immediate symptoms as well as their role in reducing the risks of osteoporosis and cardiovascular disease.
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Abstract
Objective
This study aimed to explore Australian health-care providers’ knowledge of menopause and its consequences, and their views about menopause-related health care.Methods
This was a cross-sectional qualitative study of Australian general practitioners (GPs), gynecologists (GYs) and pharmacists (PHs). Recruitment was ultimately achieved through professional networks and cold calling.Results
There were equal numbers of GPs, GYs and PHs, and equal numbers of males and females in each group. All participants demonstrated sound understanding of menopause and its consequences. A strong theme was recognition of high usage of complementary and alternative medicines (CAMs) by women for menopausal symptoms. Most participants highlighted lack of efficacy evidence for most CAMs, but the majority of GPs and PHs considered CAMs to ‘have a role’. Most supported menopausal hormone therapy (MHT) when symptoms impaired quality of life. Limitations to comprehensive care included knowledge gaps and lack of time.Conclusions
Australian health-care providers appeared knowledgeable about menopause, but uncertain about its management. MHT prescription appeared limited to women with severe symptoms despite lifestyle modification and a trial of CAMs. The upskilling of clinicians providing care for women at midlife, with respect to the indications for and prescribing of MHT, urgently needs to be addressed.
Reference
Climacteric. Health-care providers' views of menopause and its management: a qualitative study. 2021 Dec;24(6):612-617. doi: 10.1080/13697137.2021.1936486. Epub 2021 Jul 9.PMID: 34240683